Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Natriuretic peptides and integrated risk assessment for cardiovascular disease: an individual-participant-data meta-analysis
Univ Cambridge, Cambridge, England.;Med Univ Innsbruck, Innsbruck, Austria..
Univ Cambridge, Cambridge, England..
Univ Glasgow, Glasgow, Lanark, Scotland..
Univ Cambridge, Cambridge, England..
Show others and affiliations
2016 (English)In: The Lancet Diabetes and Endocrinology, ISSN 2213-8587, E-ISSN 2213-8595, Vol. 4, no 10, 840-849 p.Article in journal (Refereed) Published
Abstract [en]

Background Guidelines for primary prevention of cardiovascular diseases focus on prediction of coronary heart disease and stroke. We assessed whether or not measurement of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) concentration could enable a more integrated approach than at present by predicting heart failure and enhancing coronary heart disease and stroke risk assessment. Methods In this individual-participant-data meta-analysis, we generated and harmonised individual-participant data from relevant prospective studies via both de-novo NT-proBNP concentration measurement of stored samples and collection of data from studies identified through a systematic search of the literature (PubMed, Scientific Citation Index Expanded, and Embase) for articles published up to Sept 4, 2014, using search terms related to natriuretic peptide family members and the primary outcomes, with no language restrictions. We calculated risk ratios and measures of risk discrimination and reclassification across predicted 10 year risk categories (ie, <5%, 5% to <7.5%, and >= 7.5%), adding assessment of NT-proBNP concentration to that of conventional risk factors (ie, age, sex, smoking status, systolic blood pressure, history of diabetes, and total and HDL cholesterol concentrations). Primary outcomes were the combination of coronary heart disease and stroke, and the combination of coronary heart disease, stroke, and heart failure. Findings We recorded 5500 coronary heart disease, 4002 stroke, and 2212 heart failure outcomes among 95617 participants without a history of cardiovascular disease in 40 prospective studies. Risk ratios (for a comparison of the top third vs bottom third of NT-proBNP concentrations, adjusted for conventional risk factors) were 1.76 (95% CI 1.56-1.98) for the combination of coronary heart disease and stroke and 2.00 (1.77-2.26) for the combination of coronary heart disease, stroke, and heart failure. Addition of information about NT-proBNP concentration to a model containing conventional risk factors was associated with a C-index increase of 0.012 (0.010-0.014) and a net reclassification improvement of 0.027 (0.019-0.036) for the combination of coronary heart disease and stroke and a C-index increase of 0.019 (0.016-0.022) and a net reclassification improvement of 0.028 (0.019-0.038) for the combination of coronary heart disease, stroke, and heart failure. Interpretation In people without baseline cardiovascular disease, NT-proBNP concentration assessment strongly predicted first-onset heart failure and augmented coronary heart disease and stroke prediction, suggesting that NT-proBNP concentration assessment could be used to integrate heart failure into cardiovascular disease primary prevention. Copyright (C) 2016 The Author(s). Published by Elsevier Ltd

Place, publisher, year, edition, pages
2016. Vol. 4, no 10, 840-849 p.
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:uu:diva-317062DOI: 10.1016/S2213-8587(16)30196-6ISI: 000393025100025OAI: oai:DiVA.org:uu-317062DiVA: diva2:1086819
Funder
EU, European Research CouncilEU, FP7, Seventh Framework Programme
Available from: 2017-04-04 Created: 2017-04-04 Last updated: 2017-04-04Bibliographically approved

Open Access in DiVA

fulltext(470 kB)25 downloads
File information
File name FULLTEXT01.pdfFile size 470 kBChecksum SHA-512
22a0b6c57ce94d5238988d6652b06410242a7ff11753f9122bb8750445f0ebee1869d26c8117d525414bbaedead409fb212a7d22a9a8376613f0cf47a221723b
Type fulltextMimetype application/pdf

Other links

Publisher's full text

Search in DiVA

By author/editor
Ärnlöv, JohanLind, Lars
By organisation
Department of Medical SciencesCardiovascular epidemiology
In the same journal
The Lancet Diabetes and Endocrinology
Endocrinology and Diabetes

Search outside of DiVA

GoogleGoogle Scholar
Total: 25 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 238 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf